Sec. 21.27.945. Drug pricing list.

560 words·~3 min read·/ak/title-21/chapter-27/21-27-945

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)A pharmacy benefits manager shall

(1)provide to each network pharmacy at the beginning of the term of the network pharmacy's contract, and upon renewal of the contract, the methodology and sources used to determine the list;

(2)provide the list to a network pharmacy without charge;

(3)provide and keep current a telephone number at which a network pharmacy may contact an employee of a pharmacy benefits manager;

(4)provide a process for a network pharmacy to have ready access to the list specific to that pharmacy;

(5)review and update applicable list information at least once every seven business days to reflect modification of list pricing;

(6)update list prices within one business day after a significant price update or modification provided by the pharmacy benefits manager's national drug database provider; and

(7)ensure that dispensing fees are not included in the calculation of the list pricing.

(b)Before placing or maintaining a specific drug on the list, a pharmacy benefits manager shall ensure that

(1)if the drug is therapeutically equivalent and pharmaceutically equivalent to a prescribed drug, the drug is listed as therapeutically equivalent and pharmaceutically equivalent “A” or “B” rated in the most recent edition or supplement of the United States Food and Drug Administration's Approved Drug Products with Therapeutic Equivalence Evaluations, also known as the Orange Book;

(2)if the drug is a different biological product than a prescribed drug, the drug is an interchangeable biological product;

(3)the drug is readily available for purchase from national or regional wholesalers operating in the state; and

(4)the drug is not obsolete or temporarily unavailable.

(c)The list a pharmacy benefits manager provides to a network pharmacy under

(a)of this section must

(1)be maintained in a searchable electronic format that is accessible with a computer;

(2)identify each drug for which a reimbursement amount is established;

(3)specify for each drug

(A)the national drug code;

(B)the national average drug acquisition cost, if available;

(C)the wholesale acquisition cost, if available; and

(D)the reimbursement amount; and

(4)specify the date on which a drug is added to or removed from the list.

(d)In this section,

(1)“interchangeable biological product” has the meaning given in AS 08.80.480 ;

(2)“pharmaceutically equivalent” means a drug has identical amounts of the same active chemical ingredients in the same dosage form and meets the standards of strength, quality, and purity according to the United States Pharmacopeia published by the United States Pharmacopeial Convention or another similar nationally recognized publication;

(3)“significant price update or modification” means

(A)an increase or decrease of 10 percent or more in the pharmacy acquisition cost;

(B)a change in the methodology in which the maximum allowable cost for a drug is determined; or

(C)a change in the value of a variable involved in the methodology used to determine the maximum allowable cost for a drug;

(4)“therapeutically equivalent” means a drug is from the same therapeutic class as another drug and, when administered in an appropriate amount, provides the same therapeutic effect as, and is identical in duration and intensity to, the other drug;

(5)“therapeutic class” means a group of similar drug products that have the same or similar mechanisms of action and are used to treat a specific condition.